Conventional therapy of head and neck cancer.

Squamous cell cancers occurring at the various sites within the head and neck are remarkable for their differences with respect to clinical presentation, staging, risk of neck disease, anatomic considerations, histology, and response to conventional therapy. In general, either surgery alone or radiation alone can be used effectively for early (T1, T2, favorable T3) tumors. If surgery can be done safely and without significant disruption of normal function or cosmesis, as in early oral cavity tumors, surgery is preferable because it avoids a prolonged and uncomfortable acute treatment and long-term radiation complications. Otherwise, as in early oropharyngeal and laryngeal tumors, radiotherapy is favored. Although single modality therapy can be given for advanced disease, combined surgery and radiotherapy appear to offer improved locoregional control and enhanced survival. The status of neck nodes is a critical prognostic factor, and the neck remains the most common site of treatment failure. Consequently, treatment of the neck can never be divorced from treatment of the primary. For early neck disease, single modality therapy suffices, but for more extensive disease, combined treatment is indicated. In view of the complexity of head and neck cancer both in terms of diagnosis and treatment, management of the patient should begin in a multidisciplinary setting in which all tumor and patient factors can be evaluated and a treatment plan agreed upon by both surgeon and radiotherapist.